Acute cholecystitis and cholelithiasis developed after ... Acute postoperative cholecystitis is an...

Acute cholecystitis and cholelithiasis developed after ... Acute postoperative cholecystitis is an unusual
Acute cholecystitis and cholelithiasis developed after ... Acute postoperative cholecystitis is an unusual
Acute cholecystitis and cholelithiasis developed after ... Acute postoperative cholecystitis is an unusual
Acute cholecystitis and cholelithiasis developed after ... Acute postoperative cholecystitis is an unusual
Acute cholecystitis and cholelithiasis developed after ... Acute postoperative cholecystitis is an unusual
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  • Can J Gastroenterol Vol 17 No 3 March 2003 175

    Acute cholecystitis and cholelithiasis developed after esophagectomy

    Mitsuo Tachibana MD, Shoichi Kinugasa MD, Hiroshi Yoshimura MD, Dipok Kumar Dhar MD, Shuhei Ueda MD, Toshiyuki Fujii MD, Takeru Nakamoto MD, Ioannis Kyriazanos MD, Naofumi Nagasue MD

    Second Department of Surgery, Shimane Medical University, Enya-cho 89-1, Izumo 693-8501, Shimane, Japan Correspondence and reprints: Dr M Tachibana, Second Department of Surgery, Shimane Medical University, Enya-cho 89-1, Izumo 693-8501,

    Shimane, Japan. Telephone +81-853-20-2232, fax +81-853-20-2229, e-mail nigeka35@shimane-med.ac.jp Received for publication July 9, 2002. Accepted December 10, 2002

    M Tachibana, S Kinugasa, H Yoshimura, et al. Acute cholecystitis and cholelithiasis developed after esophagectomy. Can J Gastroenterol 2003;17(3):175-178.

    BACKGROUND: Although the prevalence of gallstone disease after gastrectomy is reported to be high, its prevalence after esophagectomy is scarcely reported. MATERIALS AND METHODS: Gallbladder disease following an esophagectomy was prospectively evaluated in 237 patients with esophageal cancer by abdominal ultrasonography twice a year up to five years postoperatively. The median follow-up period was 18.6 months. RESULTS: One patient (0.4%) developed acute acalculous chole- cystitis postoperatively, and 13 patients (5.5%) developed gallstone disease during the follow-up period. Nine (69%) of these 13 patients developed gallstone disease within two years, and another two patients developed the disease three years after esophagectomy. Another patient developed gallbladder debris at 35 months postoper- atively, and one developed gallbladder polyps at 33 months. Seven of the 13 patients with gallstone disease underwent cholecystectomy between 13 and 125 months after esophagectomy: two developed acute cholecystitis; two had associated common bile duct stones; the remaining three patients had upper abdominal pain. Nine of the 13 patients who developed gallstone disease showed a history of alco- holism, whereas only 81 of 224 patients without gallstone disease had a similar history (P

  • PATIENTS AND METHODS Between January 1981 and August 2001, 304 patients with pri- mary esophageal carcinoma were admitted to the Second Department of Surgery, Shimane Medical University, Japan. Of these patients, 248 without a history of previous gallstone disease underwent esophagectomy. All patients underwent abdominal ultrasonography (AUS) and computed tomography (CT) to rule out the presence of any gallbladder disease before surgery.

    The majority of the patients underwent a right transthoracic subtotal esophagectomy and dissection of the cervical (bilateral supraclavicular regions), mediastinal (periesophagus and around the trachea including recurrent laryngeal nerve nodes), and abdominal (perigastric region and around the celiac axis) lymph nodes. Reconstruction was usually carried out with a gastric tube through the retrosternal route and esophagogastrostomy was done through a cervical incision in the neck. The bilateral vagal nerves were divided at the level just below the tracheal bifurcation. Lymph node dissection around the hepatic pedicle was not rou- tinely done.

    At the outpatient department, patients routinely underwent AUS by specialized radiologists twice a year until five years after the operation or until the last follow-up period. Gallstones were defined as strong echo with an acoustic shadow, and debris was defined as echogenic material without acoustic shadowing. When gallbladder disease was suspected by AUS, further investigation was done by CT and/or drip infusion cholangiography. The medi- an follow-up time was 18.6 months, ranging from one to 249 months. One hundred forty-seven patients were followed at the outpatient department at one year after esophagectomy, 99 at two years, 76 at three years, 64 at four years, and 48 at five years fol- lowing esophagectomy.

    The standard χ2 test with Yates’ correction was used for com- parative analyses. The level of significance was P

  • Among those seven patients who were treated surgically, two patients underwent simultaneous common bile duct explo- ration due to the common bile duct stones. Another two patients developed acute calculous cholecystitis at 82 and 125 months, respectively, and underwent emergency cholecystec- tomy. Another three patients underwent cholecystectomy due to upper abdominal pain (Figure 3). All stones were revealed to be pigment stones by macroscopic examination.

    To determine risk factors of gallstone development after esophagectomy, the history of alcohol consumption was evalu- ated. Nine of the 13 patients who developed gallstones com- sumed more than 80 g of alchol per day over 10 years, whereas only 81 of 224 patients without gallstones consumed this amount of alcohol (P

  • CONCLUSIONS Our results indicate that a certain number of esophageal carci- noma patients develop cholelithiasis within three years after esophagectomy, and half of those subsequently undergo chole- cystectomy operation. Esophagectomized patients should be carefully followed for gallstone development at the outpatient department when he or she has a history of alcohol consump- tion.

    Tachibana et al

    Can J Gastroenterol Vol 17 No 3 March 2003178

    REFERENCES 1. Iizuka T, Isono K, Kakegawa T, Watanabe H. Parameters linked to

    ten-year survival in Japan of resected esophageal carcinoma. Chest 1989;96:1005-101.

    2. Daly JM, Karnell LH, Menck HR. National cancer data base report on esophageal carcinoma. Cancer 1996;78:1820-8.

    3. Isono K, Sato H, Nakayama K. Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncology 1991;48:411-20.

    4. Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 1994;220:364-73.

    5. Fujita H, Kakegawa T, Yamana H, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for radical lymphadenectomy for esophageal cancer. Ann Surg 1995;222:654-62.

    6. Tachibana M, Kinugasa S, Dhar DK, et al. Prognostic factors after extended esophagectomy for squamous cell carcinoma of the thoracic esophagus. J Surg Oncol 1999;72:88-93.

    7. Lerut T, Leyn PD, Coosemans W, Raemdonck DV, Scheys I, Saffre EL. Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg 1992;216:583-90.

    8. Altorki NK, Skinner DB. Occult cervical nodal metastasis in esophageal cancer: Preliminary results of three-field lymphadenectomy. J Thorac Cardiovasc Surg 1997;113:540-4.

    9. Inoue T, Mishima Y. Postoperative acute cholecystitis: A collective

    review of 494 cases in Japan. Jpn J Surg 1988;18:35-42. 10. Paull DE. Acute cholecystitis in the immediate postoperative

    period following esophagogastrectomy. Am Surg 2001;67:97-9. 11. Collard JM, Otte JB, Reynaert M, Michel L, Carlier MA,

    Kestens PJ. Esophageal resection and by-pass: A 6 year experience with a low postoperative mortality. World J Surg 1991;15:635-41.

    12. Majoor CLH, Suren TJJ. Gallbladder complications following resection of stomach for peptic ulcer. Br Med J 1947;2:8-11.

    13. Ikeda Y, Shinchi K, Kono S, Tsuboi K, Sugimachi K. Risk of gallstones following gastrectomy in Japanese men. Surg Today 1995;25:515-8.

    14. Hauters P, de Neve de Roden A, Pourbaix A, Aupaix F, Coumans P, Therasse G. Cholelithiasis: A serious complication after total gastrectomy. Br J Surg 1988;75:899-900.

    15. Wu CC, Chen CY, Wu TC, Iiu TJ, P’eng PK. Cholelithiasis and cholecystitis after gastrectomy for gastric carcinoma: A comparison of lymphadenectomy of varying extent. Hepatogastroenterology 1995;42:867-72.

    16. Kodama I, Yoshida C, Kofuji K, Ohta J, Aoyagi K, Takeda J. Gallstones and gallbladder disorder after gastrectomy for gastric cancer. Int Surg 1996;81:36-9.

    17. Inoue K, Fuchigami A, Higashide S, et al. Gallbladder sludge and stone formation in relation to contractile function after gastrectomy: A prospective study. Ann Surg 1992;215:19-26.

    18. Kameta H. Present status the type of gallstones by classification in Japan. Tan to Sui 1991,12:1179-83. (in Japanese)

    19. Nomura H, Kashiwagi S, Hayashi H, et al. Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol 1988;128:598-605.

    20. Gibney EJ. Asymptomatic gallstones. Br J Surg 1990;77:368-72. 21. Conte D, Barisani D, Mandelli C, et al. Prevalence of cholelithiasis

    in alcoholic and genetic haemochromatotic cirrhosis. Alcohol 1993;28:581-4.

    22. Tierney S, Qian Z, Lipsett PA, Pitt HA, Lillemoe KD. Ethanol inhibits sphincter of Oddi motility. J Gastrointest Surg 1998;2:356-62.

    Tachibana.qxd 2/28/03 10:02 AM Page 178

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